Skip to main content

Full text of "Medicare hospice benefits : a special way of caring for people who have a terminal illness"

See other formats


Medicare 



Hospice 



Benefits 



a special way of caring for people 
who have a terminal illness 



This booklet explains . . . 

4 The hospice program and who is eligible. 
4 Your Medicare hospice benefits, 
4 How to find a hospice program. 
4 Where you can get more help. 




HEALTH CARE FINANCING ADMINISTRATION 
The Federal Medicare Agency 



-Medicare Hospice Benefits 

(Finding what you want to know) 



Your Medicare Hospice Benefits 1 

Information on what is hospice and who is eligible for Medicare 
hospice benefits 

How Hospice Works 2-3 

Hospice Services Covered by Medicare 4 

What Is Not Covered 5 

What You Pay 6 

Includes information on your health plan coverage 

How Long You Can Get Hospice Care 7 

How to Find a Hospice Program 8 

Where to Get More Information 9-11 

Includes the telephone numbers for the State Hospice Organizations 

Index 12 

An alphabetical list of hospice topics in this booklet 



» to 



72' 



-Your Medicare Hospice Benefits- 



"When my wife was ill, . . . 
hospice arranged for a 
volunteer to come in one 
day a week so that I could 
go to the grocery store, or 
whatever needed to be 
done." 

-Max, Husband of 
a former hospice 
patient 



«-• 



CMS Lfosasy 
G2-07-13 



^Medicare will still pay 
for covered benefits for 
any health problems that 
are not related to your 
terminal illness (see 
page 6 "Can I keep my 
Medicare health plan?"). 



What is hospice? 

Hospice is a special way of caring for people who are 
terminally ill, and for their family. This care includes 
physical care and counseling. Hospice care is given by 
a public agency or private company approved by 
Medicare. It is for all age groups, including children, 
adults, and the elderly during their final stages of life. 
The goal of hospice is to care for you and your family, 
not to cure your illness. 

If you qualify for hospice care, you can get medical and 
support services, including nursing care, medical social 
services, doctor services, counseling, homemaker 
services, and other types of services (see page 4). You 
will have a team of doctors, nurses, home health aides, 
social workers, counselors and trained volunteers to 
help you and your family cope with your illness. In 
many cases, you and your family can stay together in 
the comfort of your home. Depending on your 
condition, you may have hospice care in a hospice 
facility, hospital, or nursing home. 

Who is eligible for Medicare hospice benefits? 

Hospice care is covered under Medicare Part A 
(Hospital Insurance). You are eligible for Medicare 
hospice benefits when: 

m You are eligible for Medicare Part A (Hospital 
Insurance); and 

H Your doctor and the hospice medical director 
certify that you are terminally ill and probably 
have less than six months to live; and 

a You sign a statement choosing hospice care 
instead of routine Medicare covered benefits for 
your terminal illness *; and 

H You receive care from a Medicare-approved 
hospice program. 



How Hospice Works 



"My wife received 
hospice care for 3 months 
before she passed away. 
They sent a registered 
nurse 3 times a week to 
care for her." 

-Art, Husband of a 
former hospice patient 



How does hospice work? 

Your doctor and the hospice will work with you and 
your family to set up a plan of care that meets your 
needs. The plan of care includes the hospice services 
you need that are covered by Medicare. The chart on 
page 4 lists these hospice services, including grief and 
loss counseling for your family. For more specific 
information on a hospice plan of care, call your State 
Hospice Organization (see pages 10-11). 

The care that the hospice gives you is meant to help 
you make the most of the last months of life by giving 
you comfort and relief from pain. The focus is on care, 
not cure. 

As a hospice patient, there is a team of people that will 
help take care of you. They are . . . 

^ your family 

^ a doctor 

^ a nurse 

^ clergy or other counselors 

^ a social worker 

^ trained volunteers 



How Hospice Works 



® Call your State 
Hospice Organization 
(see pages 10-1 1 ) to find 
a hospice program in 
your area. 



How does hospice work? (continued) 

Volunteers are trained to help with everyday tasks, 
such as shopping and personal care services, like 
bathing and dressing. Speech, physical, and 
occupational therapists and other persons who are 
trained to give care are also there for you when needed. 

A family member or other person who cares for you 
will be with you every day and members of the hospice 
team will make regular visits. A nurse and a doctor are 
on-call 24 hours a day, 7 days a week to give you and 
your family support and care when needed. If you 
should need care in a hospital for your illness, the 
hospice team will help arrange your stay. 

Even though a doctor is a part of the hospice team, you 
can choose to use your regular doctor, who is not a part 
of the hospice, to get care. The hospice will work 
closely with your regular doctor to give you the care 
that you need. 



Hospice Services Covered by Medicare 



What does Medicare cover? 



Medicare covers these hospice services and pays nearly all of their costs: 


Medicare Services 


Covered 


Doctor services 


• 


Nursing care 


• 


Medical equipment (such as wheelchairs or walkers) 


• 


Medical supplies (such as bandages and catheters) 


• 


Drugs for symptom control and pain relief 


• 


Short-term care in the hospital, including respite care ( see below) 


• 


Home health aide and homemaker services 


• 


Physical and occupational therapy 


• 


Speech therapy 


• 


Social worker services 


• 


Dietary counseling 


• 


Counseling to help you and your family with grief and loss 


• 



You will only have to pay part of the cost for outpatient drugs and inpatient respite 
care (see page 6 "What will I have to pay for hospice care?"). 

What is respite care? 

Respite care is care given to a hospice patient by another caregiver so that the usual 
caregiver can rest. As a hospice patient, you may have one person that takes care of 
you every day. That person might be a family member. Sometimes they need 
someone to take care of you for a short time while they do other things that need to 
be done. During a period of respite care, you will be cared for in a Medicare- 
approved facility, such as a hospice facility, hospital or nursing home (see page 6). 



What Is Not Covered 
What is not covered? 



The care that you get for your terminal illness must be 
from a hospice. When you choose hospice care, 
Medicare will not pay for: 



er 



er 



er 



Treatment to cure your terminal illness. 

As a hospice patient, you can get comfort care to 
help you cope with your illness, not cure it. 
Comfort care includes drugs for symptom control 
and pain relief, physical care, counseling, and 
other hospice services (see page 4). Hospice uses 
medicine, equipment, and supplies to make you as 
comfortable and pain-free as possible. Medicare 
will not pay for treatment to cure your illness. You 
should talk with your doctor if you are thinking 
about potential treatment to cure your illness. As 
a hospice patient, you always have the right to 
stop getting hospice care and go back to your 
regular doctor or health plan (see page 7). 

Care from another hospice that was not set up by 
your hospice. 

You must get hospice care from the hospice 
provider you chose. You cannot get hospice care 
from another hospice provider, unless you change 
your hospice provider (see page 8). 

Care from another provider that is the same care 
that you must get from your hospice. 

All care that you get for your terminal illness 
must be given by your hospice team. You cannot 
get the same type of care from a different provider 
unless you change your hospice provider (see 
page 8). 



What You Pay 



What will I have to pay for hospice care? 

Medicare pays the hospice for your hospice care. You 
will have to pay: 

■ No more than $5 for each prescription drug and 
other similar products: The hospice can charge 
up to $5 for each prescription for outpatient drugs 
or other similar products for pain relief and 
symptom control. 

• 5% of the Medicare payment amount for inpatient 
respite care: For example, if Medicare pays $100 per 
day for inpatient respite care, you will pay $5 per day. 
You can stay in a Medicare-approved hospital or 
nursing home up to 5 days each time you get respite 
care. There is no limit to the number of times you 
can get respite care. The amount you pay for respite 
care can change each year. 

Can I keep my Medicare health plan? 

Yes. You should use your Medicare health plan (like 
the Original Medicare Plan or a Medicare managed 
care plan) to get care for any health problems that are 
not related to your terminal illness. You may be able to 
get this care from your own doctor who is not a part of 
the hospice, or from the hospice doctor. When you use 
your Medicare health plan, you must pay the 
deductible and coinsurance amounts (if you have the 
Original Medicare Plan), or the copayment (if you 
have a Medicare managed care plan). For more 
information about Medicare health plans, including 
deductibles, coinsurance, and copayments, look in 
your Medicare & You handbook. If you do not have the 
Medicare handbook, you can get a free copy by calling 
1-800-MEDICARE (1-800-633-4227). 

Important information about Medicare Supplemental 
Insurance: If you are in the Original Medicare Plan, you 
may have a Medicare Supplemental Insurance or 
"Medigap" policy. Your Medigap policy still helps to 
cover the costs for the care of health problems that are 
not related to your terminal illness. Call your insurance 
company for more information. You can also call 
1-800-MEDICARE (1-800-633-4227) and ask for a free 
copy of the Guide to Health Insurance for People with 
Medicare. This guide will give you more information on 
using Medigap policies. 



How Long You Can Get Hospice Care 



Periods of care are 
important. They are a 
time when your doctor 
recertifies that you still 
need and remain eligible 
for hospice care. 



How long can I get hospice care? 

You can get hospice care as long as your doctor certifies 
that you are terminally ill and probably have less than 
six months to live. Even if you live longer than six 
months, you can get hospice care as long as your doctor 
recertifies that you are terminally ill. 

Hospice care is given in periods of care. As a hospice 
patient, you can get hospice care for two 90-day 
periods followed by an unlimited number of 60-day 
periods. At the start of each period of care, your 
doctor must certify that you are terminally ill in 
order for you to continue getting hospice care. A 
period of care starts the day you begin to get hospice 
care. It ends when your 90 or 60-day period is up. If 
your doctor recertifies that you are terminally ill, your 
care continues through another period of care. 

As a hospice patient, why would I stop 
getting hospice care? 

Sometimes a terminally ill patient's health improves or 
their illness goes into remission. If that happens, your 
doctor may feel that you no longer need hospice care 
and will not recertify you at that time. Also, as a 
hospice patient you always have the right to stop 
getting hospice care, for whatever reason. If you stop 
your hospice care, you will get your health care from 
your Medicare health plan, (like the Original Medicare 
Plan or a Medicare managed care plan). If you are 
eligible, you can go back to hospice care at any time. 

As a hospice patient, you always have the right to stop 
getting hospice care and go back to your regular doctor 
or health plan. 



Example: 

Mrs. Jones is a cancer patient who received hospice 
care for two 90-day periods of care. Mrs. Jones' 
cancer went into remission. At the start of her 
60-day period of care, Mrs. Jones and her doctor 
decided that, due to her remission, she would not 
need to return to hospice care at that time. Mrs. 
Jones' doctor told her that if she becomes eligible 
for hospice, she may be recertified and can return 
to hospice care. 



How to Find a Hospice Program- 



How can I find a hospice program? 

To find a hospice program, call your State Hospice 
Organization (see phone numbers on pages 10' 11). 
The hospice you choose must be Medicare-approved in 
order to get Medicare payment. To find out if a hospice 
program is Medicare-approved, ask your doctor, the 
hospice program, your State Hospice Organization, or 
your State Health Department. 

Can I change the hospice provider 
I get care from? 

As a hospice patient, you have the right to change 
hospice providers only once during each period of care. 



8 



Where to Get More Information 



To get help with your $► 
Medicare questions 



Where can I get more information? 

You can get more information about hospice care from: 

■ The National Hospice Organization 
1901 North Moore Street, Suite 901 
Arlington, VA 22209 
1-800-658-8898 

www.nho.org (on the Internet) 

■ The Hospice Association of America 
228 7th Street, SE 
Washington, DC 20003 
1-202-546-4759 
www.hospice-america.org (on the Internet) 

Call your State Hospice Organization to find a hospice 
program in your area (see phone numbers on pages 10-11). 

At the time of printing, these phone numbers were 
conect. Phone numbers sometimes change. To get the 
most updated phone numbers, call 1-800-MEDICARE 
(1-800-633-4227) or go to the Internet at 
www.medicare.gov under "Important Contacts." 



© Call 1-800-MEDICARE (1-800-633-4227, 
TTY/TDD: 1-877-486-2048 for the speech and 
hearing impaired) or look on the Internet at 
www.medicare.gov. 



Where to Get More Information 



Alabama 
Alaska 

Arizona 

Arkansas 

California 

Colorado 
Connecticut 

Delaware 

Florida 
Georgia 

Hawaii 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 
Massachusetts 

Michigan 

Minnesota 
Mississippi 
Missouri 



State Hospice Organizations 

Alabama Hospice Organization 

Hospice of Mat-Su | 

Hospice and Home Health of Juneau 

Arizona Hospice Organization 

Arkansas State Hospice Association 

California Hospice and Palliative Care 
Association 

Colorado Hospice Organization 

Connecticut Council for Hospice and 
Palliative Care 

National Hospice and Palliative Care 
Organization Hospice Help Line 

Florida Hospice and Palliative Care, Inc. 

Georgia Hospice Organization 

Hawaii Islands Hospice Organization 

Idaho Hospice Organization 

Illinois State Hospice Organization 

Indiana Hospice and Palliative Care Organization 

Iowa Hospice Organization 

Association of Kansas Hospices 

Kentucky Association of Hospice and 
Palliative Care 

Louisiana Hospice Organization 
Maine Hospice Council 

Hospice Network of Maryland 

Hospice and Palliative Care Federation 
of Massachusetts 

Michigan Hospice and Palliative Care 
Organization 

Minnesota Hospice Organization 

Mississippi Hospice Organization 

Missouri Hospice and Palliative Care Association 



800-355-1973 

907-3524800 
907-463-3113 

480-704-0210 

888-382-9399 

916-441-3770 

303-449-1142 

888-220-9148 
203-238-1922 

800-658-8898 

850-878-2632 

877-924-6073 
770-924-9255 

808-924-9255 

208-381-2721 

888-844-7706 

317-338-4049 

515-243-1046 

888-202-5433 
316-263-6380 

888-322-7317 

888-546-1500 
504-945-2414 

800-438-5963 
207-626-0651 

410-729-4571 

800-962-2973 
781-255-7077 

800-536-6300 
517-886-6667 

651-659-0423 

662-915-7391 

816-350-7702 



10 



Where to Get More Information 



Montana 

Nebraska 

Nevada 

New Hampshire 

New Jersey 

New Mexico 

New York 



Association of Montana Health Care Providers 

Nebraska Hospice Association 

Hospice Association of Nevada 

New Hampshire Hospice Organization 

New Jersey Hospice and 
Palliative Care Organization 

New Mexico and Texas Hospice Organization 
New York State Hospice Association 



North Carolina Hospice for the Carolinas 



North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Puerto Rico 

Rhode Island 

South Carolina 

South Dakota 
Tennessee 

Texas 

Utah 
Vermont 
Virginia 
Washington 



North Dakota Hospice Organization 

Ohio Hospice and Palliative Care Organization 

Hospice Association of Oklahoma 

Oregon Hospice Association 

Pennsylvania Hospice Network 

Puerto Rico Home Health and 
Hospice Association 

Rhode Island State Hospice Organization 

Hospice for the Carolinas 

South Dakota Hospice Organization 
Tennessee Hospice Organization 

Texas and New Mexico Hospice Organization 

Utah Hospice Organization 
Hospice Council of Vermont 
Virginia Association for Hospices 
Washington State Hospice Organization 



West Virginia Hospice Council of West Virginia 



Wisconsin 
Wyoming 



Hospice Organization of Wisconsin 
Wyoming Hospice Organization 



406-4424911 
308-687-6065 
702-796-3134 
603-228-9870 
908-233-0060 

800-580-9270 
512-454-1247 

800-611-9710 
518-446-1483 

800-662-8859 
919-677-4100 

701-237-4629 

614-485-0021 

800-356-0622 

503-228-2104 

717-230-9993 

787-897-7040 

800-338-6555 
401-444-9070 

800-662-8859 
803-791-4220 

605-668-8327 

800-638-6411 
615-228-1128 

800-580-9270 
512-454-1247 

801-321-5661 

802-229-0579 

540-686-6448 

888-459-0438 
509-456-0438 

800-788-5480 
304-529-4217 

608-233-7166 

307-362-1990 



11 



j Index — — _____ 

Coinsurance 6 

Counseling 1,4 

Dietary 4 

Grief and Loss 4 

Deductible 6 

Doctor Services 1-4 

Home Health Aide and Homemaker Services 1,4 

Hospice 

Eligibility 1 

Program 1-3, 7-9 

Services 1-4 

Team 2-3 

Hospice Association of America 9 

Medical Equipment 4 

Medical Supplies 4 

Medicare 

Health Plan Benefits 3,6 

Hospice Care Coverage 1 , 4-5 

Part A (Hospital Insurance) 1 

National Hospice Organization 9 

Nursing Care 1-2, 4 

Occupational Therapy 3-4 

Payment 4-6 

Periods of Care 7,8 

Phone Numbers to Call for Help 9-11 

Physical Therapy 3-4 

Prescription Drugs 4, 6 

Respite Care 4, 6 

Social Worker Services 1-2, 4 

Speech Therapy 3-4 

State Hospice Organizations 10, 1 1 



12 



,! 



■ - 



U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 



CHS LIBRARY 



3 ADT5 00008^50 H 



Health Care Financing Administration 
7500 Security Boulevard 
Baltimore, Maryland 21244-1850 



Publication No. HCFA 02154 
Revised March 2000 



MEDICARE • MEDICAID 

Health Care Financing Administration